Intrascleral fixation of standard capsular tension ring: a modified-simple technique for managing moderate and severe subluxated lens extraction.

BACKGROUND

Moderate-to-severe lens subluxation poses surgical challenges due to extensive zonular weakness and the need to maintain stable intraocular lens (IOL) positioning while preserving the capsular bag.

OBJECTIVES

To evaluate the outcomes and safety of a modified technique using intrascleral suture fixation of a standard capsular tension ring (CTR) to preserve the capsular bag in moderate-to-severe lens subluxation.

DESIGN

Retrospective, single-center case series.

METHODS

Consecutive eyes with 120°-300° zonular dialysis underwent phacoemulsification via a 2.4 mm clear corneal incision and a 0.8 mm lateral incision. Capsular bag stabilization was achieved by intrascleral fixation of a standard CTR using a knotless Z-suture with double-strand 8-0/9-0 polypropylene, followed by in-the-bag IOL implantation. Primary outcomes were postoperative IOL centration and corrected-distance visual acuity (CDVA); secondary outcomes included refractive error and complications. Follow-up was scheduled at 1, 3, 6 months (some at 12 months) and annually thereafter.

RESULTS

Sixteen eyes of nine patients were included. Median follow-up was 328.0 days (interquartile range (IQR) 256.5, 443.0). Median logMAR CDVA improved from 0.35 (IQR 0.30, 0.57) preoperatively to 0.19 postoperatively. Mean absolute spherical equivalent decreased from 9.82 ± 1.02 D to 1.16 ± 0.25 D. IOLs were well‑centered in 13 eyes (81.3%); a slight, clinically insignificant tilt was observed in 3 eyes (18.7%). One intraoperative posterior capsule rupture did not preclude in-the-bag IOL implantation. Two eyes had transient postoperative intraocular pressure elevation managed medically. No other significant complications occurred.

CONCLUSION

Intrascleral fixation of a standard CTR is a simple, accessible, and effective bag-preserving technique for moderate-to-severe lens subluxation, enabling stable in-the-bag IOL implantation with favorable visual and refractive outcomes.

REGISTRATION: ClinicalTrials.gov: NCT06627062.